The role of micro-RNAs in neuropathic pain-a scoping review

Neuropathic pain can be caused by a lesion or disease of the somatosensory system characterised by pathological neuro-immune alterations. At a molecular level, microRNAs (miRNAs) act as regulators of gene expression orchestrating both immune and neuronal processes. Thus, miRNAs may act as essential modulators of processes for the establishment and maintenance of neuropathic pain. The objective/aims of this scoping review was to explore and chart the literature to identify miRNAs that are dysregulated in neuropathic pain. The following databases were searched from inception to March 2023: PubMed, EBSCO, CINAHL, Cochrane Library, and SCOPUS. Two independent reviewers screened, extracted data, and independently assessed the risk of bias in included studies. The JBI critical appraisal checklist was used for critical appraisal. A narrative synthesis was used to summarise the evidence. Seven studies (total of 384 participants) that met our eligibility criteria were included in this scoping review. Our review has identified different miRNAs that are commonly involved in the chronic neuropathic pain conditions including miR-132, miR-101, and miR-199a. Our review findings further suggest that expression of miRNAs to be significantly associated with increased diabetic disease duration, HbA1C levels, and fibrinogen levels. Our review findings suggest that there is clear association between miRNA expression and chronic neuropathic pain conditions. Therefore, increasing the specificity by selecting a candidate miRNA and identifying its target mRNA is an area of future research.

Intrauterine growth-restricted piglets defined by their head shape have impaired survival and growth during the suckling period

Increased litter sizes in modern pig breeds have led to a significant number of pigs being born undersised and/or exposed to different degrees of intrauterine growth restriction (IUGR). The aim of this study was to examine the effect of piglet head shape as an identification method on performance indices. Data included all piglets from 203 litters, in total 3402 crossbred piglets. Piglets were classified at birth based on their head morphology (normal, mild IUGR and IUGR) and weighed at birth, Day 14 and at weaning (mean ± s.d.: 25.5 ± 1.23 days). The relative weight of the brain (to bodyweight) was greater in the mild IUGR (4.2%) and in the IUGR piglets (5.5%) compared with the normal piglets (2.8%) (P < 0.001). Weaning weight of the mild IUGR and IUGR piglets was reduced by 1.3 kg and 1.8 kg, respectively, compared with the normal piglets (P < 0.001). The average daily gain of the normal piglets (228 g/day) was higher than the mild IUGR (195 g/day) and IUGR piglets (181 g/day) (P < 0.001). The fractional growth rate (weight gained per day per starting weight) was, however, highest in the IUGR piglets followed by the mild IUGR and the normal piglets (P < 0.001) indicating the potential for catch up growth. Mild IUGR that were liveborn had twice as high a risk of dying before weaning than normal piglets; whereas liveborn IUGR piglets had a 4.7 times greater risk of dying pre-weaning. The present study showed that piglets born with a ‘dolphin-like’ head shape have an impaired growth and increased risk of dying in the suckling period.

Implementation of an Emergency Medical Card and a Continuity of Care

Objectives: To describe the design and implementation procedures for an emergency medical card (EMC) and a continuity of care (CoC) report using the continuity of care record (CCR) standard. We also describe studies to evaluate the effectiveness of these documents in Co C.

Methods: We convened weekly planning, design, development, implementation, and evaluation meetings, involving 25 outpatient clinics at Intermountain Healthcare. The CCR standard schema and documentation from American Society for Testing and Materials were used to develop the data model. An outside consultant provided further advice on committee-approved designs. We then developed a functional design document for the CCR application implementation. Healthcare professionals (medical doctors and physician assistants) and fourth-year medical students will simulate the will simulate the EMC and CoC report use and assess their usefulness in Co C. The reviewers will review three randomly selected patient cases, using patient information in the electronic medical record, EMC and CoC report. A structured questionnaire with Likert scale will assess the reviewers’ perceptions of the documents’ usefulness in medical decision making. Other studies will compare patient- and HCP-entered data to evaluate the effect of patient-entered data on the quality of HCP-entered data and assess user-satisfaction with the documents’ usefulness in Co C.

Results: An automated CCR application compliant with the CCR standard was developed and integrated in an already implemented patient portal at the Intermountain Healthcare clinics. Patients use the application to view, add, modify their information and use the data plus EMR data to create EMC and CoC report.

Conclusions: The CCR standard can be used to implement an application to enable patients to not only view but add or modify personal health records, and create, print and share paper EMC and CoC report with HCPs. The documents can be created using HCP-maintained EMR data, in addition to patient-entered data as is currently the norm.

Intrauterine growth-restricted piglets have similar gastric emptying rates but lower rectal temperatures and altered blood values when compared with normal-weight piglets at birth

Intrauterine growth-restricted (IUGR) piglets have lower survival rates and are more likely to have empty stomachs 24 h after birth than normal piglets. Although hypoglycemia may result from low colostrum intake per se, it is not known if slow gastric emptying may be an additional risk factor for poor immunization and glucose absorption in IUGR piglets. It is estimated that IUGR piglets consume less colostrum per kilogram BW than normal-weight piglets within the first 24 h, which could be due to a slower gastric emptying rate and a compromised energy metabolism. Therefore, we hypothesized that the gastric emptying rate and blood glucose would be lower in IUGR piglets. We investigated gastric emptying rates in normal and IUGR piglets and blood glucose and rectal temperatures at birth and after 15, 30, 60, and 120 min. In addition, blood parameters relevant for metabolism were studied. Forty-eight piglets (24 normal and 24 IUGR) were classified at birth as either normal or IUGR on the basis of head morphology. Piglets were removed from the sow at birth before suckling, and birth weight was recorded. Pooled porcine colostrum was tube-fed to all piglets at 12 mL/kg BW as soon as possible after birth (t = 0 min). The piglets were randomly allocated to be euthanized at 15, 30, 60, and 120 min (all groups, = 6) after bolus feeding, and the weights of the stomach and its residuals were recorded. There was no difference in gastric emptying rates between normal and IUGR piglets ( = 0.129); however, gastric DM residuals tended to by greater in IUGR piglets than normal piglets ( = 0.085). Overall, IUGR piglets had lower rectal temperatures (36.2°C ± 0.2°C vs. 37.5°C ± 0.2°C; < 0.001) and plasma glucose levels (2.8 ± 0.2 vs. 4.1 ± 0.2 mmol; < 0.001) than normal piglets. Interactions between piglet classification and time were observed in plasma values for NEFA, -3-hydroxybutyrate, albumin, aspartate, and alanine amino transferase, with greater levels in normal piglets at 15 min ( < 0.05) and 30 min for bile acid ( < 0.05) compared to IUGR piglets. In conclusion, the gastric emptying rates between normal and IUGR piglets were similar, but gastric DM residuals tended to be greater in IUGR piglets. Differences were observed in blood values and rectal temperatures, with lower values in IUGR piglets. Therefore, it is likely that factors like hypothermia and possibly reduced metabolic function are more important during the first hours after birth than gastric retention per se.

Individual physical characteristics of neonatal piglets affect preweaning survival of piglets born in a noncrated system

The aim of this study was to investigate the effects of individual physical characteristics on preweaning survival and growth of piglets born in a noncrate system. Data were collected from 3,402 neonatal piglets from 203 Landrace × Yorkshire sows housed in noncrate pens in a commercial Danish sow herd. Piglets were categorized into groups according to their survivability: surviving to weaning (SURV), stillborn (STILL), or dead between birth and weaning (DBW), which was subdivided into dead d 0 to 1 after farrowing (DEAD1) or dead d 2 to 26 after farrowing (DEAD26). Linear models were used to determine which physical characteristics affected survivability and growth of piglets. Results showed that characteristics related to the individual piglets had a greater degree of explanatory power in relation to survival than variables related to the sow. Survival of piglets increased if piglets were females (P < 0.001), had a greater body mass index (P < 0.001), and were born to sows of parity 3 or more (P = 0.017). Piglets with a greater birth weight were more likely to survive (P < 0.001), but birth weight was inferior to body mass index in explaining differences between SURV and DBW. Piglets that died 2 to 26 d after birth had a lower birth weight (P < 0.001), were born to sows of parity 1 or 2 (P = 0.014), and were born after a shorter gestation (P = 0.011) compared with SURV. Piglets that died on d 0 to 1 after birth had a lower body mass index (P < 0.001), displayed a greater degree of growth restriction (P = 0.004), and were born in large litters (P = 0.005). The gender of the piglets affected survivability at both d 0 to 1 (P < 0.001) and d 2 to 26 (P < 0.001). Piglets in DEAD1 differed from STILL by having a shorter crown to rump length (P < 0.001), a birth weight that deviated more from the mean weight of the litter (P = 0.001), and being more likely to be born before d 116 of gestation (P = 0.008). The only physical characteristic that was important for growth performance in the suckling period was birth weight (P < 0.001), yet using only birth weight as an indicator for survivability was too simplistic. The results of this study emphasize that individual characteristics of neonatal piglets could serve as indicators of survivability of piglets born in noncrate systems; however, the results suggest that the importance of characteristics differed in different periods of the preweaning period.

Patient-perceived usefulness of an emergency medical card and a continuity-of-care report in enhancing the quality of care

OBJECTIVE

To evaluate the patients' opinion on the usefulness of the electronic medical card (EMC) and continuity-of-care report in enhancing quality of care, and to assess the effects of the patient-entered data on the quality of data in the electronic medical record (EMR).

DESIGN

A structured survey assessed patients' opinion on the usefulness of the EMC and continuity-of-care report. The accuracy of EMR data involved comparing the patient-entered data in the continuity-of-care report with the healthcare-provider-entered data in the EMR. The analysis assessed whether the EMR information was consistent with the patient-entered data. A data completeness evaluation compared data entries in the EMR collected before and after the use of continuity-of-care record application.

RESULTS

One hundred and thirty-three patients used the application, of which 76% who had actually used the EMC and continuity-of-care report to seek medical care and/or update EMR information were surveyed. Age was associated with the reported usefulness of the documents. Few users (16%) printed the continuity-of-care reports to take to their healthcare providers for data updates and fewer (9%) to correct errors in the EMR. Overall, 68% of patients found the documents to be useful.

CONCLUSIONS

Patients reported that the EMC and continuity-of-care report were useful in enhancing quality of care. They were able to identify missing or erroneous data in the EMR data, making them an important source of quality control for their information in the healthcare-provider-maintained EMR.

Dynamics of activated escape and its observation in a semiconductor laser

We report a direct experimental observation and provide a theory of the distribution of trajectories along which a fluctuating system moves over a potential barrier in escape from a metastable state. The experimental results are obtained for a semiconductor laser with optical feedback. The distribution of paths displays a distinct peak, which shows how the escaping system is most likely to move. We argue that the specific features of this distribution may give an insight into the nature of dropout events in lasers.

The treatment of severe self-injurious behavior by the systematic fading of restraints: effects on self-injury, self-restraint, adaptive behavior, and behavioral correlates of affect

Severe self-injurious behavior (SIB) in people with mental retardation is difficult to treat when dangerously frequent or intense responding rules out functional analysis and interventions that permit free responding. This situation is common when restrictive devices, such as straight arm splints, are used. In this study, the effects of introducing flexion into a straight-arm splint, on SIB, self-restraint, adaptive behavior, and behavioral correlates of affect were examined for three individuals with severe mental retardation. Using single-case design methodology, for two individuals self-injury was reduced to zero, while the overall level of restriction was also significantly reduced. From the observed behavioral correlates of affect, there was no evidence of an increase in negative affect with the introduction of the new splint and the fading procedure, but there was evidence of an increase in positive vocalizations. Engagement in activities and social contact were not affected by the introduction of the new splint. The reasons for a decrease in SIB with a corresponding decrease in restriction in the absence of any manipulation of contingencies for SIB are discussed, with particular reference to stimulus control.

Cytokine production and fatigue in patients with chronic fatigue syndrome and healthy control subjects in response to exercise

We have studied the relationship between the cytokine production induced in vivo by prolonged isometric exercise and the symptom complex marked by fatigue in patients with chronic fatigue syndrome (CFS). Twelve male patients and 13 matched male control subjects undertook an isometric hand-grip exercise protocol utilizing dynamometers. Subjects undertook 30 minutes of exercise, for which the target force was set at 40% of the maximal voluntary contraction and the duty cycle was 50%. Prior to, during, and for 24 hours following the exercise, blood samples were collected and assayed for the presence of cytokines, including interferon-gamma and interferon-alpha, interleukin-1 beta, and tumor necrosis factor-alpha. At those times subjects also completed the Profile of Mood States (POMS) questionnaire, which served as a measure of changes in subjective fatigue. No significant alteration in the level of any of the cytokines in the plasma of patients or control subjects was detected before, during, or after exercise. Surprisingly, the patients' levels of fatigue, depression, and confusion, as measured by the POMS, decreased in response to the exercise. These data do not confirm the presence of an immunologic process correlating with the exacerbation of fatigue after exercise experienced by patients with CFS. Limitations in the study design and in the sensitivity of the cytokine assays may have affected our results.